Connecticut Apple Rehab center Legionnaires outbreak: 1 dead, 1 ill

Two residents of the Connecticut Apple Rehab nursing facility in Rocky Hill were sickened with Legionnaires’ disease, and one of them died from their disease, Connecticut health officials said.

The Connecticut Department of Public Health (DPH) released a statement that it, along with officials at Apple Rehab Rocky Hill, are “continuing a joint investigation to identify the environmental source of Legionella bacteria to protect patients, staff, and visitors.”

The statement continued: “DPH was notified on July 17, 2019, of a resident of the facility with Legionnaires’ disease. Legionella bacteria were also found in water samples tested by the facility.”

Legionnaires’ disease is a potentially deadly respiratory infection that is caused by inhaling microscopic water droplets (mist or vapor) that contain Legionella.

Officials of the Connecticut Apple Rehab facility said they have informed patients, staff, and visitors of the presence of Legionella in the water system. “We have one definitive case of Legionnaires’ disease and have notified our residents and families,” officials said in a statement. “We are proactively monitoring patients with new symptoms such as fever, chills, muscle aches, and cough for at least three months.”

Apple Rehab has 24 nursing facilities in Connecticut and Rhode Island. Rocky Hill is a city of about 20,000 11 miles south of Hartford, and the Apple Rehab nursing facility is located at 45 Elm Street.

Two residents of the Connecticut Apple Rehab nursing facility in Rocky Hill were sickened with Legionnaires’ disease, and one victim has died from the disease.

Connecticut Apple Rehab outbreak: residents at risk

Most people who are exposed to Legionella bacteria do not get sick, but residents of the Connecticut Apple Rehab facility are among the group of people – those 50 years old and older – who are most susceptible to contracting the disease. Additionally, anyone with a chronic lung condition, such as COPD (chronic obstructive pulmonary disorder, most commonly bronchitis or emphysema) and current or former smokers are also highly susceptible.

Other demographics that are more susceptible to infection include:

• organ-transplant recipients
• people on a specific drug protocol, such as corticosteroids
• alcoholics.

The list also includes people with immune systems that are suppressed because they suffer from:

• frequent and recurrent pneumonia, bronchitis, sinus infections, ear infections, meningitis or skin infections
• organ inflammation or infection
• blood disorders, such as anemia
• digestive problems, such as cramping, appetite loss, diarrhea, and nausea
• delayed growth and development.

After Legionnaires’ disease is diagnosed, hospitalization is almost always necessary. Too, the most serious cases can develop complications such as respiratory failure, kidney failure, and septic shock, and as was the case with one victim in this outbreak, death can occur.

Connecticut Apple Rehab outbreak: remediation begun

The Centers for Disease Control and Prevention (CDC) conducted a study in 2015 that concluded that “75 percent of (Legionnaires’ disease) acquired in health-care settings could be prevented with better water management.”

That being said, remediation efforts have begun at the Rocky Hill facility. The water system is undergoing chlorine treatment, and additional environmental testing is expected as the DPH monitors the facility’s water quality and preventative measures.

For its part, the DPH began routine surveillance of Legionnaires’ disease cases in the state in 1997. In the 20 years since then, annually reported cases have ranged from a low of 15 to a record high last year of 201.

Connecticut Apple Rehab outbreak: multiple symptoms

The CDC estimates that there are about 25,000 cases of pneumonia due to Legionella bacteria (scientific name: Legionella pneumophila) annually in the U.S. Only 5,000 – or 20 percent – of those cases are reported, however, because of the disease’s nonspecific symptoms.

Legionnaires’ disease – which is also called legionellosis or Legionella pneumonia – develops anywhere from two to 10 days after one has been exposed to Legionella, and the disease generally begins with:

• headaches
• muscle aches
• fever, which can reach 104 degrees Fahrenheit, if not higher
• chills.

By Day 2 or 3, symptoms can worsen to include:

• coughing, which can produce mucus or blood
• shortness of breath (called dyspnea)
• chest pains (called pleurisy, pleuritis, or pleuritic chest pains)
• gastrointestinal symptoms, such as diarrhea, nausea, and vomiting
• confusion and other mental changes.

Although Legionnaires’ disease primarily affects the lungs, it also can cause infections in wounds and other parts of the body, including the heart.